General Paeds

Question 1

Describe how the non pharmalogical behavioural technique method Tell-Show-Do is used in a clinical setting

Answer 1

Explain, demostrate and then perform procedure
Reduces anxiety, fear of the unknown and uncertainty

• Tell - explain procedure but ensure this is age appropriate (Young children bugs for bacteria and magic wand for 3 in 1)
• Show - demonstrate what you are going to do
• Do - do exactly what was said/shown

Question 2

What are the three main features of conscious sedation?

Answer 2

1. Patient is conscious
2. Patient independently retains protective reflexes
3. Can understand and respond to verbal stimuli throughout

Question 3

What type and duration of splint should be placed for an alveolar fracture?

Answer 3

4 weeks hard splint

Only trauma with a hard splint (think bone so hard)

Question 4

What type and duration of splint should be placed for a intrusive luxation?

Answer 4

4-8 weeks flexible splint

Question 5

Describe the ugly duckling phase

Answer 5

Natural physiological stage of development between the ages of 8-11 ½

1. The unerupted upper canine crowns impact the roots of the laterals
2. This causes the roots of the laterals to tilt mesially, impacting the roots of the centrals
3. The central roots therefore, also tilt mesially
4. This causes the crowns of the maxillary incisors to flare out laterally, leaving a midline diastema
5. Once the 3s erupt, the incisors are pushed back together, naturally closing the space between the central incisors

Question 6

At what age does the molar relationship become established during normal developmental growth?

Answer 6

Occurs when the lower 6s drift mesially following the loss of primary E’s (10-12 years old)

Question 7

What is an acute debilitating illness?

How can this affect dentition if a baby has this?

Answer 7

An acute debilitating illness is any acute illness which makes someone seriously unwell or perhaps results in hospitalisation. This can include serious childhood infections, septicaemia, severe asthma resulting in hospitalisation etc.

This causes the body to prioritise healing over amelogenesis (if occurring simultaneously). Therefore, the calcification of teeth undergoing amelogenesis at the time of an acute debilitating illness will be affected.

• Crown defects: hypomineralisation or hypocalcification
• Hypodontia
• Impacted or ectopic teeth
• Delayed development and eruption

Question 8

What type and duration of splint should be placed for a extrusive luxation?

Answer 8

2 weeks flexible splint

If there is marginal bone breakdown then splint for an additional 3-4 weeks

Question 9

Should splints following trauma be placed buccally or palatally following trauma? Why?

Answer 9

Should always be placed buccally to allow for endo access and stop occlusal interferences

Question 10

Describe the term leeway space

Answer 10

The difference between the combined mesio-distal widths of the Cs, Ds and Es compared to the 3s, 4s and 5s
Due to the widths of the said primary teeth being wider, there is thus space for the permanent teeth to drift

Upper arch = 1mm
Lower arch = 2mm

Question 11

What type and duration of splint should be placed for an avulsion?

Answer 11

2 weeks flexible splint (wet)
4 weeks flexible splint (dry)

Question 12

Describe how the non pharmalogical behavioural technique method ‘Patient control’ is used in a clinical setting

Answer 12

• Give the patient an option of using a stop signal e.g. raised hand
• Can offer patient choice of treatment where possible e.g. if they require multiple fillings, ask which tooth/side they would like today

Question 13

What are the indications for fissure sealants?

Answer 13

• Children with special needs
• Children with extensive caries in primary dentition
• Children with caries in permanent molars
• Children with high caries risk
• 6s, 5s, 4s, 2s, Ds, Es with deep pits and fissures, stained fissures, complex fissure patterns or deep cingulum pits

Question 14

What are some signs of neglect to look out for in a patient?

Answer 14

• Signs of physical abuse: intra oral and extra oral
• Poor OH
• Untidy appearance
• Lack of interaction
• Absent/glazed look
• Contradicting info between patient and parent
• History of trauma
• History of parents not attending dental appointments

Question 15

What are the contraindications for fissure sealants?

Answer 15

• Allergy to sealant materials
• Difficult to obtain moisture control and non-cooperative
• Cavitated carious lesions

Question 16

What is behavioural shaping?

Give an example of this

Answer 16

Behaviour shaping is the heirarchical exposure to the dental environment (baby steps)

Can be achieved by the reinforcement of desired behaviour progressing towards ideal behaviour.
Positive reinforcement for desired behaviour such as keeping their mouth open for check up and saying “you’re doing very well!” or rewarding with a sticker. This increases the probability of that behaviour being repeated; while ignoring undesirable behaviours to avoid drawing attention to them.

Question 17

What type and duration of splint should be placed for a subluxation?

Answer 17

2 weeks flexible splint

Question 18

What are the indications and contraindications for GA?

Answer 18

INDICATIONS
* Pre-cooperative child
* Uncooperative child with special care
* Pain or infections which cannot be managed by other means
* Severe anxiety: unable to cope with treatment under LA or sedation
* Multiple extractions in more than one quadrant
* Allergy to LA

CONTRAINDICATIONS
* Significant comorbidities: complex cardiac problems, neuromuscular disorders
* Allergies to drugs used during GA

Question 19

How would you manage suspected neglect in a dental practice?

Answer 19

• Ask the parent if there are any problems first
• Assess the child for signs of neglect
• Talk to the child alone and allow them to volunteer information. Don’t ask leading questions. Record notes in child’s words.
• Discuss with experienced colleagues
• Following conversation, if concerns subside, carry out dental care and keep record of concerns
• If concerns still exist following discussions, provide any urgent dental care, talk to the child and parent and explain your concerns, inform them of your decision to refer them to social services.
• Refer to social services and follow up in writing within 48 hours. Confirm referral has been received and acted upon. Be prepared to write a report for case conference if needed.

Question 20

Define early childhood caries

Answer 20

The presence of 1 or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger (younger than 6)

Question 21

List FOUR types of pulp therapy for decidious molars

Answer 21

Indirect pulp capping
Direct pulp capping - not recommended
Pulpotomy (coronal removal)
Pulpectomy (complete removal)

Pulpotomy (o for coronal) Pulpectomy (e for everything)

Question 22

What are some risk factors of neglect?

Answer 22

• Parent is a drug/alcohol abuser
• Parent suffering from mental health problems
• History of intrafamilial violence
• Previous maltreatment of animals
• Pre-existing disability in the child
• Vulnerable/supported parents/carers

Question 23

What are some complications that can arise from subluxation? (6)

Answer 23

1. Pulpitis (damage pulp tissue)
2. Tooth discolouration (damaged blood vessels)
3. Periodontal disease
4. Tooth mobility
5. Root resorption
6. Infection

Question 24

When would you be concerned about a maxillary central incisors eruption?

Answer 24

• When the contralateral incisor has erupted more than 6 months prior
• Both upper central incisors haven’t erupted and the lowers have erupted more than 12 months prior
• Deviation from normal eruption sequeunce (ie laterals before centrals)

Question 25

List 4 advantages of MTA

Mineral Trioxide Aggregate

Answer 25

• Good seal
• Sets in moisture
• Biocompatible
• Radiopaque

Question 26

What type and duration of splint should be placed for a root fracture?

Answer 26

4 weeks flexible splint
4 months flexible splint if cervical area

Question 27

What is the most reliable indicator of ankylosis of a infraoccluded (submerged) primary tooth root?

Answer 27

Vertical step in the interproximal bone around the infra-occluded tooth

Question 28

What are questions you need to ask a patient if they come to you with an avulsed tooth?

Answer 28

• How it happened? ask parent as well and look for discrepancies in answers and assess body language- signs of abuse
• When it happened? treatment is time dependent
• Where it happened? the tooth may have been in soil e.g if it was a sports injury. It follows that a patient’s tetanus status should also be assessed
• If the patient lost any consciousness? may need referral to GP/hospital
• Ask if the tooth has been kept in milk/saline/liquid and how long it was dry for

Question 29

What are some red flags for neglect when asking a parent if there are any problems?

When assessing neglect and you ask the parent is everything ok?

Answer 29

• Confrontational
• Hostile
• Aggressive
• Lack of concern
• Pre-occupied
• Self-centred behaviour

Question 30

How do you follow up a patient you have treated for an avulsed tooth?

Answer 30

EPT and endo-frost to assess necrosis of tooth.
Percussion to assess ankylosis.
Radiographs also taken.

Question 31

What medical complication would you consider as the main contraindication to pulp therapy?

Answer 31

Congenital Heart Defects

Question 32

At what point should you decide to use MTA during apexification?

Mineral Trioxide Aggregate

Answer 32

Failure to form hard tissue barrier after 2 years with calcium hydroxide

Question 33

Describe how the non pharmalogical behavioural technique method ‘Graded experience and acclimitisationl’ is used in a clinical setting

Answer 33

• Graded experience: Graded introduction to dental environment, with non-threatening/non-invasive procedures first e.g. check up/fluoride varnish
• Acclimitisation: repeat simple interventions, build familiarity and add new procedures one at a time